Transcript Slide 1

Engaging Community
Participants and Partnerships.
Program Fidelity and
Sustainability
June Simmons, CEO
Our shared great cause
• Wisconsin and California have shared
vision
• California Departments of Aging and
Public Health have designated a non-profit
to serve as the program office for the
Chronic Disease Self-Management
Program
• And future evidence-based health
programs
Partners in Care Foundation:
Mission
• Partners in Care Foundation changes the
shape of healthcare and social services so
they work better for everyone. With our
community collaborators and funders,
Partners develops, tests, and disseminates
high-impact, innovative and proven models
of care that bring more efficient and effective
health and social services to diverse people
and communities.
Our Framework for Change
• Identify an issue that is relevant to our
mission and strengths:
– Impacts a large population
– Causes significant suffering and harm
– Costly – significant expenditures in place
– Promising – opportunity for high impact
through innovation
– Proving ground available—evidence-based
– Sustainable
The Strategic Environment –
challenges and opportunities
• U.S. health care system is in crisis
• Failings of system are profound and
widely acknowledged
• Pressure is building for
transformation
US lags compared to others!
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47th in life expectancy at birth
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78 years vs. 82 in Japan
#1 in Spending: 16% of GDP
Abysmal 4% Improvement in mortality 1998-2003
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vs. 21% in UK, 13% in France & Canada, 19% Australia
Mortality Amenable to Health Care - Best to Worst 2003 (deaths/100,000)
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1997-98
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High Costs and Poor Outcomes
• Spend twice any other developed
country
• Ranked 37th in world on health
outcomes
• 40 million uninsured
• Little prevention/lots of expensive late
care
• Growing role for community and family
caregiving and self-care
Shift in Population Causes
Major Redesign of Health
System
• Longer life span – delayed disability
– Sanitation and medicine reduce infections
– Joint and organ replacements
– Medications, cancer treatments, AIDS drugs
• Shift from episodes of injury and illness to
CHRONIC PROGRESSIVE CONDITIONS
80% of Health Dollars Spent on
Chronic Conditions
• 31% of Americans are obese
• Adults are not physically active (28-34% aged
65-74; 35-44% aged 75+)
• Rates of obesity in children (16-33%)
• Type II diabetes skyrocketing – 40% increase in
’90s. 6.9% of Americans; 20% among 65+
• Ethnic health disparities dramatic
Ethnic Health Disparities:
Diabetes Among Hispanics
Admissions for uncontrolled diabetes without complications
per 100,000 population, age 65 and over, by ethnicity, 2004
160
139.1
Admissions per 100,000
140
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80
60
42.6
40
28.4
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Total
White
2006 National Healthcare Disparities Report
Hispanic
40% of Deaths in U.S. Due to
Modifiable Risk Factors
• Smoking was king
• Obesity and lack of physical
activity
• Chronic conditions result:
– Diabetes
– Respiratory conditions
– Cardiovascular
– Arthritis
– Cancer
Determinants of Health and Contribution to
Premature Death
Genetic
Predisposition
30%
Behavioral
Patterns
40%
Health Care
10%
Environmental
Exposure
5%
Social
Circumstances
15%
Source: Stephen A. Schroeder, MD. We Can Do Better. NEJM 357:12
The Scope of the Problem
• 1.7 million Americans die of a chronic disease each year
• Chronic diseases affect the quality of life of 90 million
• 87% of persons aged 65 and over have at least one
chronic condition; 67% have 2 or more
• 99% of Medicare spending is on behalf of beneficiaries
with at least one chronic condition.
What is a chronic disease?
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Arthritis
Chronic lung disease
Diabetes
Heart condition
Cardiovascular disease
Chronic pain
Depression
Cancer
Stroke
Any ongoing health condition
Four chronic conditions cause 2/3 of all deaths a year.
Heart Disease, Cancer, Stroke and Diabetes
Need to work with whole
person, family and community
• Facing complex and fragmented system
• Need to integrate personal care and
medical care
• Interdisciplinary team needed
• Fundamental re-design is required – in
large, complex system
New Models of Care are
Needed
• Reallocation of existing dollars from care
to prevention and promoting health
• Strengthen community and home care –
reduce use of institutions
• Reduce fragmentation – increase
integration to address chronic diseases
The Expanded Chronic Care Model: Integrating Population Health Promotion
Building a “Health” system
• Healthcare must change
• The Aging Network must seize the
opportunity to partner with primary care
• Josefina Carbonnal has provided the great
vision – converting aging services to
health-building and health empowerment
resources
• We have the opportunity to lead
Changing American Culture
• We are in the service of a great vision
– Mainstreaming access to powerful tools for
health
– Building a platform for better quality of life
• Less pain
• Less illness
• Greater mobility and better function
– This is a MISSION, not a PROJECT
Launching Lasting Change
• Current projects are “seed money” to
launch a new movement
• Need to identify and involve many
“investors” in order to take this to scale
• Scale = creating a new norm for healthy
living
• Scale = new norms for widespread ready
access to proven programs and services
Going to Scale
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This is challenging work – needs to:
Reach large numbers of people
Maintain fidelity
Be sustainable/cost-effective and
consumer-engaging
Going to Scale In Wisconsin…..
• Over 700,000 people 65 and older
• 67% = nearly 500,000 older citizens with 2
or more chronic conditions
• California…..even more
• Who to target? How many can we reach?
• This is a significant dream – to broadly
impact quality of life through enhanced
self-care…behavior change/lifestyle
change
Major Assumptions
• Lasting Change
• Converting Aging Network to a Platform for
Health
• Aging Network Leading Conversion of
Other Systems to Platforms for Health
• Moving From Projects to Tipping Points
• Cannot Work Alone!!! – Partners Essential
• 80/20 Rule
Building a “Franchise” For Health
• Essential Forms of Capital to Invest
– Mission/Vision
– Leadership
– Organizational Commitment
– A Community of Peers – a Movement
– Mandates, competitive forces, glory,
accountability
– Capital – Money & Other Resources
Sources of Shared Leadership:
Bringing Vision & Expectations
• AoA and NCOA
• State Departments of Aging and Public
Health
• 4 A’s/ AAA’s/ Aging Network
• Other Systems --- 80/20 Rule
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Alignable Incentives
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Funders
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Associations
Focus of Intervention –
Behavior Change
• New Models of Care – Practice Change
– Systems
– Organizations
• New Ways of Living
– Individuals
California Evidence-Based Initiative 2006
• California Departments of Aging
and Health awarded 3-year
grant from Administration on
Aging
• Initiative brings evidencebased programming to agebased organizations
• Partners in Care is the state
program office, California
Health Innovation Center
AoA Evidence-Based Programs
• Matter of Balance:
Managing Concerns about Falls
• Healthier Living:
Managing Ongoing Health Conditions
• Healthy Moves for Aging Well
• Medication Management Improvement System
(MMIS)
Target Sectors For
ADOPTION/ENGAGEMENT
Parks
and
Rec.
Public
Health
Sector
Senior
Housing
Sites
Senior
Centers
Hospitals
EvidenceBased
Project
Office
Mental
Health
Sector
FaithBased
Orgs
Health
Plans
Physician
Groups
Community
Colleges
80/20 Selection Criteria
• Potential for Scale/Impact
– Directly/Indirectly
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Mutual Benefit/Alignable Incentives
Aligned Mission/Vision
Product Champion
Has Relevant Resources
Selection Criteria
• Organizations with Aligned Mission Who:
• Have a heart for it - Care about this
movement
• Can assign resources for the work
• Will Benefit From Engagement Over Time
– Obligations
– Needs
– Outcomes
Investments in Local Leadership
• Selection is vital
• Need to screen for commitment
• Need terms of commitment in order to be
trained
• Need resources to sustain and nurture the
network of MTs and LLs
• Must anticipate attrition, but design to
minimize it
Key players
• CDA/Public Health – lead Aging Network
• Foundations – fund specific elements:
sectors/locales/expanded volume served
• Health Plans/Physician Groups
– Pay for Performance
– Marketing
– Improve Health/Reduce Health Service Use
• Community Sponsors for CDSMP
– Education and sites
Target Sectors For
ADOPTION/ENGAGEMENT
Physician
Groups
Public
Health
Sector
Senior
Housing
Sites
Senior
Centers
Hospitals
California
Health
Innovation
Center
Mental
Health
Sector
FaithBased
Orgs
Community
Colleges
Health
Plans
Parks
and
Recreation
California Collaborative Models
• Need partners that can:
• Identify & connect participants – e.g.
physicians
• Provide quality, sustainable platform, e.g.
community college adult education
• Sponsors and sites, e.g. health plans,
senior centers
State Leadership
• Guide strategy development for
public/private partnership
• Select non-profit program office
• Provide key resources through CDA and
Public Health – advocacy, website
• Encourage private sector funding for
shared long term sustainability
GIS ensures that programs are available in the most
advantageous locations to reach the target population
and identify programmatic gaps.
Examples of partnerships
• Community College Older Adult Programs
and K-12 Resources
• Disease-Specific Organizations
• Public Health and Community Clinics
• Physician Groups, especially managed
care
• Faith Based Settings
Kaiser a Vital Partner
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Original research site for Stanford
System-wide commitment
Generous community benefit
Experience with the program
California’s
Community
College
Older Adult
Programs
CAPG
• Non-profit Trade Association
• Represent approximately 150 physician
organizations
– 59,000* Physicians
– 15 million Californians
CAPG Mission
• CAPG is the Voice of Organized Medicine
• Nation’s largest professional association
representing physician groups practicing in
managed care
• Committed to the delivery of coordinated, quality,
affordable and accessible healthcare
Tools
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Physician group readiness assessment
Patient screening and referral criteria
Education tools for office/clinical staff
Referral forms
Fax back form for CBO
Models of Delivery
• Partnership with
Community
– Referral
– Accesses community
based network
– create min-networks
• Examples
– Santa Cruz
– LA Medi-Cal groups
• Hosted on Site
– Incorporate into health
education or case
management
– Larger groups, some with
hospital systems
• Examples
– Healthcare Partners
– Sharp Healthcare
California Examples
• Statewide Steering Committee
• County Coalitions/Associations
• Expansion & Sustainability Think Tank
– Identify Strategic Sectors for Partnership
– Identify Funding to go to Scale and Extend
Timeframe for Funded Leadership
– Identify Lasting Infrastructure to Sustain
Expansion & Sustainability
Workgroup
Purpose: Guidance to the CA Depts. of Aging and Public Health
to craft a comprehensive expansion and sustainability plan
Members:
– Health Plans:
– Foundations:
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Education:
Non-Profit:
Government:
Business:
Catholic Health Care West; Kaiser Permanente;
St. Joseph Health System; Daughters of Charity
Archstone Foundation; UniHealth Foundation
The CA Endowment; CA HealthCare Foundation
Kaiser Permanente Community Benefit
Community College Educators of Older Adults
Partners in Care Foundation
Los Angeles County Public Health Department
Pacific Business Group on Health
Catholic Healthcare West: A Leading
Not For Profit Health System
FY2007
• 8th largest health system in the nation
• Largest hospital provider in California
• Hospitals: 41
• Assets: $10.5 billion
• Acute Care Beds: 8,539
• Active Physicians: 9,688
• Full-time Equivalent Employees:
42,845
• General Acute Patient Care Days:
1.7 million
• Community Benefits & Care of the
Poor: $922 million*
* Including unpaid costs of Medicare
2005 – Five Year System Objective
Horizon 2010
• By 2010, reduce hospital admissions by 5% for
ambulatory care sensitive conditions by
expanding and/or enhancing primary care
services for persons with disproportionate unmet
health needs.
(Revised in 2007)
18 CHW
Hospitals
Implementing
CDSMP
(black font)
The Partners Model: Adaptation
ner
Part
Dis
sem
Bro inate
App aden ,
lica
tin
Idea to Change
Healthcare
Partners in Care:
Collaboration
Innovation
Impact
,
te
ua ,
al ve e
Ev Pro rov
p
Im
an
Pl
&
nd
u
F
Take evidence-based practice to new environments,
adapt for extended use, disseminate results, begin
again with new partners.
The Franchise for Health
• Current programs are just the beginning
• New evidence-based resources are
emerging
• The platform we develop can adopt and
spread new knowledge and resources
over time
• Will only work if we maintain fidelity
Use evaluation results to improve
Learn
ner
Part
Refine
Eva
lu
Pro ate,
Imp ve,
rov
e
Idea to Change
Healthcare
Partners in Care:
Collaboration
Innovation
Impact
nd
Fu
Use evaluation results to determine what worked, what
didn’t work so well, improve the intervention, and decide
whether to move to the next stage.
an
Pl
Seize the Opportunity
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A time of potential transformation
Must rise to the occasion
Going to scale is key
This will take more time than we planned
Need commitment at all levels
It is well worth the journey
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